Improving the management and care of psychosis patients in the West

Members of the CLAHRC West effectiveness team are working on a number of psychosis related projects.

From 1 June CLAHRC West’s Sarah Sullivan and team will be starting a study to investigate the management of people who have recovered from psychosis and have been discharged to primary care. They will interview discharged service users and their carers, clinicians involved in discharge decisions and GPs to find out what care is required and how it may be possible to meet these needs.
They will also be carrying out a secondary care audit of all discharges of people with psychosis over the previous 12 months in Bristol in order to find out the size of the problem, as well as collecting consultation data from their primary care records. A part-time Research Associate has recently been employed to work on this study. The data collected will lead to the development of a care model, which will be the topic of a future grant application to test this model using a randomised controlled design to find out how effective it is at reducing relapse and re-referral to a psychiatric inpatient unit.

They are also writing the full application to set up a Psychosis Health Integration Team (HIT) through Bristol Health Partners. This HIT aims to improve outcomes and reduce unmet need in psychosis and will be co-directed by Sarah Sullivan, Martin Jones (chair Bristol CCG) and Simon Downer (consultant psychiatrist) as well as by a service user who is yet to be appointed.

They are collaborating with Avon & Wiltshire Mental Health Partnership Trust and Otsuka Pharmaceutical Europe Ltd to use electronic medical notes data to investigate the possibility of identifying people with psychosis who have repeated relapses and therefore frequent readmissions to inpatient units. They will use methodologies such as instrumental variables analysis to overcome some of the flaws in routinely collected clinical data. This data will also be available to investigate other issues such as why the introduction of Crisis teams has resulted in higher levels of involuntary admissions to hospital whilst reducing voluntary admissions and whether polypharmacy of antipsychotics is associated with repeated admissions and other poorer outcomes.

They are also using an existing cohort of first episode psychosis patients to investigate the association between duration of untreated psychosis and clinical outcomes using instrumental variables analysis. This will reduce the confounding effect of variables such as premorbid function and mode of illness onset.

Primary care data is being used to develop a risk assessment tool to help GPs identify patients who are developing a psychotic illness. This study will investigate associations between non-specific prodromal symptoms and a later diagnosis of psychosis, using a matched case control design. They are also investigating how the rate of consultation for each symptom change as the date of diagnosis approaches.